| 1. |
- Aydin-Schmidt, Berit, et al.
(author)
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Field Evaluation of a High Throughput Loop Mediated Isothermal Amplification Test for the Detection of Asymptomatic Plasmodium Infections in Zanzibar
- 2017
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In: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 12:1
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Journal article (peer-reviewed)abstract
- Background New field applicable diagnostic tools are needed for highly sensitive detection of residual malaria infections in pre-elimination settings. Field performance of a high throughput DNA extraction system for loop mediated isothermal amplification (HTP-LAMP) was therefore evaluated for detecting malaria parasites among asymptomatic individuals in Zanzibar. Methods HTP-LAMP performance was evaluated against real-time PCR on 3008 paired blood samples collected on filter papers in a community-based survey in 2015. Results The PCR and HTP-LAMP determined malaria prevalences were 1.6% (95% CI 1.3-2.4) and 0.7% (95% CI 0.4-1.1), respectively. The sensitivity of HTP-LAMP compared to PCR was 40.8% (CI95% 27.0-55.8) and the specificity was 99.9% (CI95% 99.8-100). For the PCR positive samples, there was no statistically significant difference between the geometric mean parasite densities among the HTP-LAMP positive (2.5 p/mu L, range 0.2-770) and HTP-LAMP negative (1.4 p/mu L, range 0.1-7) samples (p = 0.088). Two lab technicians analysed up to 282 samples per day and the HTP-LAMP method was experienced as user friendly. Conclusions Although field applicable, this high throughput format of LAMP as used here was not sensitive enough to be recommended for detection of asymptomatic low-density infections in areas like Zanzibar, approaching malaria elimination.
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| 2. |
- Björkman, Berit, et al.
(author)
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Are radiographers prepared to meet children with special needs, when seen for an examination?
- 2017
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In: Acta Radiologica. - : Sage Publications. - 0284-1851 .- 1600-0455. ; 58:1 Suppl., s. 16-16
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Journal article (peer-reviewed)abstract
- Introduction: Anxiety is often experienced by children undergoing health care procedures, and children with autism spectrum disorders (ADS) experience more anxiety than typically developed children. A prerequisite for obtaining an optimum procedure is firstly based on the health care provider’s knowledge about children with ASD, but may also depend on the use of guidelines. Two previous national surveys showed, that none radiology or paediatric departments and a minority of anaesthesiology departments throughout Sweden use specific guidelines when seeing children with ASD. Following, the purpose was to develop guidelines to use when caring for and preparing children with ASD in those settings.Methods: A modified Delphi method was used, including19 experts identified from the two afore mentioned surveys. The questions considered in the process, proceeded from previous research and the results from the surveys. The experts’ responses regarding the importance of each item, were analysed and scrutinized between each round.Results: The Delphi process resulted in guidelines consisting of 15 items and a checklist with 16 aspects. The items cover the areas: planning and involving parents, features in the environment, use of time, communication, thehealth care professionals. The checklist covers the child’spattern of communication, anxiety, sensory stimuli, special interests and likes/dislikes.Conclusions: To obtain an optimum caring encounter when a child with ASD is seen in the preoperative and radiology setting, a meticulous planning is important and the environment should be adjusted for the needs of the child. To accomplish this, guidelines need to be in place and be followed.
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| 3. |
- Björkman, Berit, et al.
(author)
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Children's and parents' perceptions of care during the peri-radiographic process when the child is seen for a suspected fracture
- 2016
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In: Radiography. - : Elsevier BV. - 1078-8174 .- 1532-2831. ; 22:1, s. 71-76
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Journal article (peer-reviewed)abstract
- Background Visiting a Radiology department may elicit both positive and negative feelings for children and parents alike. This study investigated children's and parents' perceptions of care during the peri-radiographic process and whether these perceptions correlated with the child's perceptions of pain and distress. Methods This study utilized a quantitative descriptive design. Its data was collected in five Radiology departments, two where examinations are performed exclusively on children and three that treat both children and adults. Data collection contained questionnaires from children (n = 110) and their parent (n = 110) as well as children's self-reports of pain and distress. Results The findings illustrated that the children and their parent were satisfied with the care provided throughout the peri-radiographic process, unrelated to the child's self-reported levels of pain and distress or examination setting (i.e. children's department or general department). The highest scores of satisfaction were ascribed to “the radiographer's kindness and ability to help in a sufficient way,” whereas “available time to ask questions and to meet the child's emotional needs” received the lowest scores. Conclusions Parents and children alike perceived the radiographers as skilled and sensitive throughout the examination, while radiographers' time allocated to interacting with the child was not perceived be sufficiently covered.
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| 4. |
- Björkman, Berit, et al.
(author)
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Peri-radiographic guidelines for children with autism spectrum disorder : a nationwide survey in Sweden
- 2017
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In: Child Care Health and Development. - : Wiley-Blackwell. - 0305-1862 .- 1365-2214. ; 43:1, s. 31-36
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Journal article (peer-reviewed)abstract
- OBJECTIVE: This study aimed to investigate the prevalence of guidelines and routines used nationwide when children with autism spectrum disorder (ASD) are taken care of and examined in a radiology department during a peri-radiographic process.METHOD: A nationwide survey was compiled and distributed to 94 radiology departments throughout Sweden, i.e. those performing more than 100 000 radiographic examinations annually. The survey was designed as a web questionnaire with seven questions on possible guidelines and/or routines for the departments when preparing and taking care of children with ASD in conjunction with a radiographic procedure. The data were scrutinized, using descriptive statistics.RESULTS: In total, 86 radiology departments responded to the survey (response rate 92%). Of those departments, 40 did not examine children with ASD. None of the departments included in the study had existing guidelines underpinning the routines when preparing and performing radiographic examinations for children diagnosed with ASD. A few departments (n = 8) would set aside more time for the procedure if it were known in advance that the child to be examined had been diagnosed with ASD. Also, some departments (n = 7) had radiographers who were more experienced in the care of children who would be appointed to perform examinations for children with ASD.CONCLUSION: It is suggested that guidelines should be developed in order to increase interaction in a supportive way and decrease anxiety during the peri-radiographic process with children with ASD.
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| 5. |
- Björkman, Berit, et al.
(author)
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Plausible scenarios for the radiography profession in Sweden in 2025
- 2017
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In: Radiography. - : Elsevier. - 1078-8174 .- 1532-2831. ; 23:4, s. 314-320
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Journal article (peer-reviewed)abstract
- Introduction: Radiography is a healthcare speciality with many technical challenges. Advances in engineering and information technology applications may continue to drive and be driven by radiographers. The world of diagnostic imaging is changing rapidly and radiographers must be proactive in order to survive. To ensure sustainable development, organisations have to identify future opportunities and threats in a timely manner and incorporate them into their strategic planning. Hence, the aim of this study was to analyse and describe plausible scenarios for the radiography profession in 2025.Method: The study has a qualitative design with an inductive approach based on focus group interviews. The interviews were inspired by the Scenario-Planning method.Results: Of the seven trends identified in a previous study, the radiographers considered two as the most uncertain scenarios that would have the greatest impact on the profession should they occur. These trends, labelled "Access to career advancement" and "A sufficient number of radiographers", were inserted into the scenario cross. The resulting four plausible future scenarios were: The happy radiographer, the specialist radiographer, the dying profession and the assembly line.Conclusion: It is suggested that "The dying profession" scenario could probably be turned in the opposite direction by facilitating career development opportunities for radiographers within the profession. Changing the direction would probably lead to a profession composed of "happy radiographers" who are specialists, proud of their profession and competent to carry out advanced tasks, in contrast to being solely occupied by "the assembly line".
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| 6. |
- Björkman, Berit, et al.
(author)
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Swedish radiographer’s experiences of their work-performance when possessing increased knowledge in reporting
- 2017
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In: Acta Radiologica. - : Sage Publications. - 0284-1851 .- 1600-0455. ; 58:1 Suppl., s. 24-24
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Journal article (peer-reviewed)abstract
- Introduction: Radiographers are today facing various challenges as the technical equipment is getting more advanced and the examinations encounter patients with complex medical records. Furthermore, in the Swedish context, radiology departments are struggling with shortage of both radiologists and radiographers. Following, this has led to a work-situation where radiologists are not always in place during emergency duty, and radiographers’are taking on additional responsibility. Hence, there is a need for further and deeper knowledge within areas that previously was undertaken solely by radiologists. One such area is reporting; and a 7.5 ECTS course was designed and offered to registered radiographers. The aim was to investigate radiographer’s experience of their work-performance and contribution to the clinic after attending this particular course in reporting.Methods: The study had a qualitative design based on individual and semi-structured interviews with 34 radiographers who attended the course in reporting the fall of 2013, 2014 and 2015. The interviews were transcribed verbatim and analysed using qualitative content analysis.Results: The analysis resulted in a comprehensive theme: Width and depth in the professional practice. This theme embraced three categories: Increased knowledge, Professional recognition, Work satisfaction.Conclusions: Increased knowledge in reporting is necessary to meet the demands from the diagnostic departments. A course in reporting on advanced level is a tool for deeper understanding of the medical image. However, there will still be challenges and constraints during the path to be a fully specialized radiographer in reporting. There is a need for more courses in this area on the second and third level.
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| 7. |
- Björkman, Berit, et al.
(author)
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The meaning and consequences of amputation and mastectomy from the perspective of pain and suffering
- 2017
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In: Scandinavian Journal of Pain. - : Elsevier. - 1877-8860 .- 1877-8879. ; 14:1, s. 100-107
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Journal article (peer-reviewed)abstract
- BackgroundThe concepts ‘pain’ and ‘suffering’ are frequently treated as synonymous. However, they are clearly distinct phenomena. Phantom phenomena including pain and sensory disturbances are still recognized as long-lasting problems after limb amputation and after mastectomy. The complex nature of phantom phenomena makes the interpretation of its results ambiguous, regarding the prevalence of pain, sensory disturbances and the accompanying suffering. There is clinical experience that suffering is a great burden for the individual but there is a lack of systematic studies of patients’ own evaluations of the suffering caused by their phantom phenomena.ObjectivesThe overall aim of this study was to identify and describe patients’ suffering related to, and as a part, of their post-amputation situation.MethodsThe present study constitutes a part of a prospective, two-year follow up project investigating interviews of 28 men and women in different ages and who have undergone a limb amputation or mastectomy. The reason for amputation or mastectomy varied among the patients and included vascular diseases, cancer (sarcoma and breast-cancer) and trauma. Our ambition was to extract as much variations as possible in different, individualized aspects of the actual pain and suffering producing situation. The participants were, here, invited to open-ended, narrative-oriented interviews one month after the surgery. The interviews were transcribed verbatim and analyzed within qualitative methodology: thematic content analysis.ResultsTwenty-two of 28 interviewees experienced phantom pain and phantom sensations. The two surgical processes amputation and mastectomy meant for a majority of the interviewees a critical event with threatening consequences for everyday life such as loss of function and personal integrity. Nine interviewees felt even stigmatized as a result of their lost body part. Numerous inter-related factors following the amputation/mastectomy, which can inflict severe suffering on the amputee, were uncovered. The context in which the interviewees were informed about the decision to amputate proved to be one such critical and important factor.ConclusionTo understand potential suffering in relation to phantom phenomena, it will never be enough merely to have knowledge of the underlying physiological or neurological mechanisms and/or the intensity of phantom pain and phantom sensations. Rather, it is necessary to find out how the loss of the body part and its everyday consequences are experienced by patients.ImplicationsIt is important to create time for real dialogue with the patients both during pre-operative preparation and post-operative rehabilitation in order to clarify and verbalize elements that constitute the patients individual suffering. Hopefully this strategy can alleviate future chronic pain problems, severe psycho-social distress and suffering. Such an approach ought to have impact also for perceived suffering after other types of surgery or different invasive treatments.
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| 8. |
- Gimbler Berglund, Ingalill
(author)
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Developing guidelines in nursing care of children with Autism Spectrum Disorder in high technology health care settings
- 2017
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Doctoral thesis (other academic/artistic)abstract
- Introduction. The high technology environment such as a radiology and anaesthesia department in a typical health care setting can many times be a frightening environment for children. Children with neurodevelopmental disorders, such as Autism Spectrum Disorder (ASD), have problems with communication and social interaction. They are dependent on routines and can have higher sensitivity to sensory stimuli than other children. These children are one group who constitutes special challenges in reducing anxiety and creating participation in a high technology environment. This can make them prone to frightening encounters in health care settings if not cared for with special consideration.Aim: The overall aim of this thesis was to audit and enhance the care of children in a high technology environment in the health care system with a focus on children with Autism Spectrum Disorder.Methods: A descriptive design was used with both qualitative and quantitative methods. In Study I, 32 nurse anaesthetists were interviewed to explore the actions and experiences of caring for children in a high technology environment using a qualitative method, known as the Critical Incident Technique (CIT). In the two following studies (Study II, III) a cross-sectional design was used and two national surveys were performed to obtain knowledge on the status in Sweden regarding the care of children with ASD in high technology environments. Sixty-eight anaesthesia departments, 38 paediatric departments and 86 radiology departments responded to the survey. Descriptive statistic was used for the answers apart from the comments part of the questionnaire where qualitative content analysis was used. Due to the limited existence of guidelines in these environments, the creation ofevidence-based guidelines was performed in Study IV, using a Delphi method. The Delphi study was based on information gleaned from the previous studies and from the literature, and 21 experts identified in Study II and III were the expert panel developing the guidelines.Result: Nurses identified children with special needs such as children with ASD as a vulnerable group in a high technology environment (Study I). Seven departments in the anaesthesia context had guidelines for caring for children with ASD in the perioperative context. In the other departments, the care of children with ASD was dependent on the knowledge of the nurse presently working there (Study II). None of the radiology departments in Sweden had guidelines on how to care for children with ASD going through a radiographic examination without anaesthesia (Study III). As a result of Study I, II and III, the need for structured guidelines for caring for children with ASD in a high technology context was identified and a set of guidelines and a checklist was created. The guidelines relate to the organisational structure for the care of children with deficits in social interaction, communication, sensory sensitivity and dependence on routines. The checklist relates to gleaning information about the specific child to be able to give person-centred care based on the specific characteristic of the child (Study IV).Conclusion: Nurses working in a high technology environment in health care have diverse experiences of preventing anxiety in children with ASD coming for a challenging procedure. There are a limited number of evidence-based guidelines to decrease anxiety and to create participation in this group ofchildren. Evidence-based guidelines were created as a tool for enhancing person-centred care in a high technology environment for this group of children. The fact that several problems are assembled under one disorder makes ASD a useful condition to have as a basis for formulating national guidelines. Guidelines that cater for the care of children with ASD in a high technology environment using a person-centred approach may also extend to the care for children with other neurodevelopmental disorders that exhibit some of the same problems as children with ASD.
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| 9. |
- Gimbler Berglund, Ingalill, et al.
(author)
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Management of children with Autism Spectrum Disorder in the anesthesia and radiographic context
- 2017
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In: Journal of Developmental and Behavioral Pediatrics. - : Wolters Kluwer. - 0196-206X .- 1536-7312. ; 38:3, s. 187-196
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Journal article (peer-reviewed)abstract
- Objective: As a primary objective, this study purports to develop guidelines to better care for children with autism spectrum disorder (ASD), particularly regarding these children's preparation for anesthesia and radiologic procedures.Methods: Using a Delphi method with an online distribution of questionnaire, guidelines for caring for children with ASD were created. Twenty-one participants were included in the expert panel. These participants were working with children with ASD in several anesthesia and radiology departments in Sweden. A list of items was created from a previous survey and the literature. In the first round, the items with <60% agreement were discarded. Items were merged, and a new list was created. Two more similar rounds were performed. In the last 2 rounds, 21 participants responded, and 80% agreement was considered to be consensus.Results: The final guidelines consisted of 14 items and a checklist of 16 factors. The 5 areas covered by the items and the checklist were as follows: planning involving parents/guardians, features in the environment, and use of time, communication, and the health care professionals. The organization was important in making it possible for the health care professional to care for the individual child according to the child's needs. It was important to involve the parents/guardians to obtain knowledge about the functioning of the child.Conclusion: A caring encounter involving a child with ASD in the anesthesia and radiology contexts requires advance planning, catered specifically to the individual needs of each child. To accomplish this, general knowledge regarding ASD and ASD's particular manifestation in the child entrusted to their care, is required from the health care workers. The organization needs to have structures in place to facilitate this process.
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| 10. |
- Gimbler Berglund, Ingalill, et al.
(author)
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Perioperative and anesthesia guidelines for children with autism : A nationwide survey from Sweden
- 2016
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In: Journal of Developmental and Behavioral Pediatrics. - : Wolters Kluwer. - 0196-206X .- 1536-7312. ; 37:6, s. 457-464
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Journal article (peer-reviewed)abstract
- Objective: The overall aim of this study was to describe the current set of guidelines for the preparation and care for children with autism spectrum disorder (ASD) in the perioperative setting across Sweden and explore the content of these guidelines in detail.Method: An online questionnaire was distributed to the chairpersons of all anesthesia departments (n = 68) and pediatric departments (n = 38) throughout Sweden. Follow-up phone calls were made to those departments that did not return the questionnaire. The presence of guidelines was analyzed through descriptive statistics. These guidelines and comments on routines used in these departments were analyzed inspired by conventional content analysis.Results: Seven of the 68 anesthesia departments and none of the 38 pediatric departments across Sweden have guidelines for preparing and/or administering care to children with ASD within the perioperative setting. From the guidelines and routines used, 3 categories emerge: "lacking the necessary conditions," "no extra considerations needed," and "care with specific consideration for children with ASD." These 3 categories span a continuum in the care. In the first category, the anesthesia induction could result in the child with ASD being physically restrained. In the last category, the entire encounter with the health care service would be adapted to the specific needs of the child.Conclusion: There is a lack of evidence-based guidelines specifically designed to meet the needs of children with ASD in the preoperative period in Sweden. Further research is needed to understand if children with ASD would benefit from evidence-based guidelines.
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